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DVT prophylaxis remains an issue for trauma surgeons
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DVT prophylaxis remains an issue for trauma surgeons
KOHALA COAST, Hawaii — Even though most of the attention regarding deep vein thrombosis and pulmonary embolism prevention is focused on total joint reconstruction in the orthopedic community, trauma surgeons also have to deal with this problematic issue, according to a former president of the American Academy of Orthopaedic Surgeons.
“The problem in trauma is here,” Richard F. Kyle, MD, said at an industry-supported CME breakfast seminar at Orthopedics Today Hawaii 2010. “You absolutely need to use prophylaxis against deep vein thrombosis (DVT) and pulmonary emboli (PE) in trauma patients,”
Kyle, who is co-chair of the trauma track at the meeting, noted the complication rate from DVT prophylaxis in trauma is the same as it is in total joints 1% to 2%. However, the patients are different.
“This is a different population from the total joint patients,” he said. “The average age is 45 years-old, the gender is mostly male and the length of stay is significantly longer than total joint replacement. The average injury severity score is about 23.”
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Unlike DVT prophylaxis in total joint replacement, there are few high-powered studies in the literature for DVT prevention in trauma.
“Literature reviews prior to 1997 reported that the incidence of VTE was anywhere from 0.4% to 19%. That just means that nobody really knows,” Kyle said. “The literature since 1997 is powered a little better and it reports from 0.4%. However, comorbidities in these patients, which include head and chest injuries, compound the problem.”
For his patients, Kyle uses Coumadin routinely for all lower extremity trauma, tibial plateau, pilon and hip fractures. “For a simple ankle fracture where the patient will be up and around, I use aspirin,” he said.
His regimen includes starting the patient on Coumadin the night of surgery, keeping the International Normalized Ratio (INR) levels between 1.5 and 2. “I continue treatment out to 10 days. If they are in bed or immobilized I will go 6 weeks. And similar to total joint replacement, I use aspirin and mechanical prophylaxis.”
Kyle said that trauma contraindications for PE prophylaxis include inter-cranial hemorrhage, spinal cord injury and lower extremity trauma that won’t allow the use of mechanical prophylaxis.
Bristol-Myers Squibb provided support for the seminar.
- Reference:
Kyle RF. CME Breakfast Seminar: Prevention of DVTs in the Orthopedic Practice. Presented at Orthopedics Today Hawaii 2010. Jan. 10-13, 2010. Kohala Coast, Hawaii.